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Falla cardíaca como manifestación temprana de hipertiroidismo neonatal: caso clínico / Heart failure as early manifestation of neonatal hyperthyroidism: case report
Alvarado S., Jorge Luis; Fernández V., Zhirly Andrea.
  • Alvarado S., Jorge Luis; Fundación Cardiovascular de Colombia. Departamento de Pediatría. Unidad de Neonatología. Floridablanca. CO
  • Fernández V., Zhirly Andrea; Salud Total. Empresa Promotora de Salud.
Rev. chil. pediatr ; 85(2): 207-212, abr. 2014. ilus
Article in Spanish | LILACS | ID: lil-711582
RESUMEN

Introducción:

Hipertiroidismo neonatal es una condición usualmente autolimitada, generalmente asociada al paso transplacentario de anticuerpos estimulantes de tiroides, secundario a enfermedades autoinmunes maternas. Detectar oportunamente a las madres con estos antecedentes, permitirá disminuir el riesgo de eventos adversos fetales.

Objetivo:

Presentar un caso de hipertiroidismo neonatal, asociado a falla cardíaca y restricción del crecimiento intrauterino, Caso clínico Recién nacido de 36 semanas, peso de nacimiento 1.240 g. Evolucionó con taquicardia, frialdad distal, exoftalmos, hepatomegalia y temblores. Ecocardiograma descartó alteración cardíaca estructural. Por hallazgos maternos sugerentes de hipertiroidismo, se realizaron exámenes encontrando TSH de 0,01 uUI/ml, T4 libre de 7,7 ng/dl, con lo que se confirmó el diagnóstico de hipertiroidismo neonatal. Se manejó con metimazol y propanolol con resolución de los síntomas y descenso de los niveles de T4 libre.

Conclusiones:

Conocer los antecedentes maternos permite identificar y manejar las complicaciones neonatales del hipertiroidismo. La falla cardíaca y otras alteraciones cardiopulmonares son los factores determinantes de la mortalidad en el período neonatal temprano. Debe haber un seguimiento a los recién nacidos de riesgo.
ABSTRACT
Neonatal hyperthyroidism is usually a self-limited condition frequently associated with transplacental passage of thyroid stimulating antibodies secondary to maternal autoimmune disorders. To timely detect mothers with this medical antecedents decreases the risk for fetal adverse events.

Objective:

To report a case of neonatal hyperthyroidism associated with intrauterine growth restriction and heart failure. Case report A 36 week-old newborn with birth weight of 1,240 g. Symptoms were tachycardia, distal coldness, exophthalmos, hepatomegaly and tremors. Echocardiogram ruled out structural heart disorders. Due to maternal symptoms suggestive of hyperthyroidism, TSH tests were performed showing 0.01 ulU/ml, free T4 7.7 ng/dl, so the diagnosis of neonatal hyperthyroidism was confirmed. It was treated with methimazole and propanol, alleviating the symptoms and decreasing the levels of free T4.

Conclusions:

To know the maternal history helps identify and manage neonatal complications of hyperthyroidism. Heart failure and other cardiopulmonary disorders are determinants of mortality during early neonatal period. High-risk newborns should receive follow up assessments.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Heart Failure / Hyperthyroidism Type of study: Prognostic study Limits: Humans / Male / Infant, Newborn Language: Spanish Journal: Rev. chil. pediatr Journal subject: Pediatrics Year: 2014 Type: Article Affiliation country: Colombia Institution/Affiliation country: Fundación Cardiovascular de Colombia/CO

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Full text: Available Index: LILACS (Americas) Main subject: Heart Failure / Hyperthyroidism Type of study: Prognostic study Limits: Humans / Male / Infant, Newborn Language: Spanish Journal: Rev. chil. pediatr Journal subject: Pediatrics Year: 2014 Type: Article Affiliation country: Colombia Institution/Affiliation country: Fundación Cardiovascular de Colombia/CO